Reflex sympathetic dystrophy (RSD, or RSDS) is a pain disorder in which the patient suffers from chronic pain and muscle damage, usually in an arm or leg. Although the exact cause of RSD is unknown, doctors believe it is triggered when a person suffers an injury that damages the nerves. However, not all people who contract RSD experienced an injury, and in these cases, doctors suspect the disease is related to an inappropriate immunological response. RSD is also called Type I of complex regional pain syndrome.
In a person with RSD, the damaged nerves are unable to regulate blood flow properly. This causes the body to develop problems with blood vessels, bones, muscles, and skin. The symptoms of RSD include bone and muscle pain, muscle spasms, discolored or thinning skin, intense skin sensitivity or burning sensations, increased perspiration, and swelling and stiffening of the joints.
Some RSD sufferers experience chronic, yet manageable symptoms. However, more advanced RSD can cause irreversible damage, such as muscle wasting, chronic muscle contracture (that leads to limited movement), and ongoing pain. Prognosis is dependent on when the disease is diagnosed. Without early intervention, RSD can be crippling.
Although a diagnosis of RSD alone will not qualify you for disability, you can still win approval if the Social Security Administration (SSA) finds that your RSD prevents you from working.
Medically Determinable Impairment. First, to even consider you for disability, the SSA must find that your RSD is a "medically determinable impairment," meaning that there is some objective evidence that you suffer from RSD. This means that your doctor must have documented physical findings in addition to your subjective complaints of pain. Some examples of objective medical evidence of RSD might be swelling, changes in skin color, temperature, or texture, changes in the amount of sweat you produce, abnormal hair or nail growth, documented osteoporosis, or involuntary movements.
Assessment of Abilities. Secondly, the SSA will determine if you can still do your old job, or if you can perform less demanding work, despite the symptoms of your RSD. To make this determination, the SSA will prepare a residual functional capacity assessment (RFC) that evaluates how your RSD affects your ability to perform certain job-related activities.
An RFC is based in part on the medical evidence you have provided to support your claim, including your doctor's opinion on your functional limitations. The SSA may also ask friends, neighbors, and co-workers about your limitations, to see if their opinions coincide with your statements that pain prevents you from doing certain activities. Also, you may be referred to a doctor hired by the SSA to undergo an examination (called a consultative examination, or CE).
You should ask your doctor to fill out an RFC form that outlines his opinion on how your illness affects your ability to work (in particular, to stand, walk, and lift). If possible, your doctor should compare what your capabilities were before the onset of RSD and after the onset of RSD. Although the SSA will consider opinions provided by any licensed medical care provider, it gives more weight to the opinions of doctors that specialize in the treatment of RSD. It is important that you provide the SSA with medical records dating to when you were first diagnosed or earlier.
An RFC for a person with RSD will include limitations imposed by the diminished muscle strength or flexibility of the affected limbs. A person who has lost significant use of one arm will have difficulty pushing, pulling, lifting, and carrying even lightweight objects. Someone who cannot fully perform these activities would be unable to do most secretarial, janitorial, or factory work.
Also, people in the advanced stages of RSD may develop soft bones, a complication called osteomalacia. Osteomalacia increases the risk of a bone fracture from even the slightest injury. An RFC for someone with osteomalacia might state that the individual could not work where there was the possibility of injury, such as in carpentry, welding, automotive, farming, or other construction type jobs.
The SSA is also required to consider your statements about how pain prevents you from working, including how intense the pain is, how long it lasts, and how limiting it is. The SSA will decide if your statements are credible based on your entire case record. For more information on pain symptoms and credibility, see our article on how Social Security evaluates chronic pain symptoms.
The SSA will also consider mental impairments that stem from your condition. For example, RSD causes significant pain in the muscles, joints, and bones, and chronic pain frequently leads to anxiety or depression that can interfere with the ability to work. If you receive treatment from a psychologist or psychiatrist, you should report this to the SSA. The SSA will then prepare a mental RFC that details any psychological limitations. For example, chronic pain can interfere with concentration and make it hard to complete tasks on time; also, depression and anxiety often lead to frequent absenteeism. These limitations, combined with the physical restrictions caused by your RSD, could most likely preclude full-time employment.
For more information on how the SSA uses the RFC to decide if you can work, see our articles on disability and the RFC.
To be eligible for disability for any impairment, you can't be working and earning more than about $1,200 per month. Also, your illness must prevent your employment for at least 12 months.
In addition, to receive SSDI, you must have worked and paid taxes to the SSA (FICA taxes) for a number of years. For more information, see our article on eligibility for SSDI.
SSI benefits are for people without a qualifying work history that meet the SSA's income and asset limit. For more information, see our article on SSI eligibility.